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\begin{document}

\title{The Musculoskeletal Disorders in Diabetic Patients and the Evaluation of
their Relationship with Metabolic Parameters and Microvascular
Complications}



\author[1]{Pelin Edis}%
\author[1]{Nilufer Ozdemir }%
\author[1]{Zeliha Hekimsoy}%
\affil[1]{Manisa Celal Bayar University}%


\vspace{-1em}



  
  \date{May 27, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
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\selectlanguage{english}
\begin{abstract}
Background: Diabetes mellitus has been associated with many different
musculoskeletal system problems. Objective: This study aims to show the
prevalence of musculoskeletal disorders in patients with diabetes and to
reveal their relationship to the metabolic parameters and microvascular
complications. Methods: Seven hundred two diabetic patients who
consecutively applied to our clinic between March 2017 and February 2018
were included in this prospective cross-sectional study. The
relationship of the musculoskeletal disorders including carpal tunnel
syndrome, Dupuytren's contracture, adhesive capsulitis, flexor
tenosynovitis, limited joint mobility syndrome, Charcot arthropathy,
diabetic foot and gout to the patients' age, gender, type of diabetes,
duration of diabetes, metabolic parameters, and microvascular
complications were evaluated. Results: Musculoskeletal system disorders
were detected in 45.9\% (n = 322) of the 702 diabetic patients evaluated
in our study. The most common disorders were carpal tunnel syndrome
17.7\% (n = 124), Dupuytren's contracture 14.4\% (n = 101), and adhesive
capsulitis 13.8\% (n = 97). A statistically significant relationship of
the HbA1c level with Dupuytren's contracture, carpal tunnel syndrome,
and adhesive capsulitis was detected (p\textless{}0.05). Conclusions:
Patients' age, duration of diabetes, HbA1c level, and presence of
microvascular complications are associated with musculoskeletal
disorders in this population.%
\end{abstract}%



\sloppy


\textbf{The Musculoskeletal Disorders in Diabetic Patients and the
Evaluation of their Relationship with Metabolic Parameters and
Microvascular Complications}

\textbf{Abstract}

\textbf{Background} : Diabetes mellitus has been associated with many
different musculoskeletal system problems. \textbf{Objective} : This
study aims to show the prevalence of musculoskeletal disorders in
patients with diabetes and to reveal their relationship to the metabolic
parameters and microvascular complications.

\textbf{Methods:} Seven hundred two diabetic patients who consecutively
applied to our clinic between March 2017 and February 2018 were included
in this prospective cross-sectional study. The relationship of the
musculoskeletal disorders including carpal tunnel syndrome, Dupuytren's
contracture, adhesive capsulitis, flexor tenosynovitis, limited joint
mobility syndrome, Charcot arthropathy, diabetic foot and gout to the
patients' age, gender, type of diabetes, duration of diabetes, metabolic
parameters, and microvascular complications were evaluated.

\textbf{Results} : Musculoskeletal system disorders were detected in
45.9\% (n = 322) of the 702 diabetic patients evaluated in our study.
The most common disorders were carpal tunnel syndrome 17.7\% (n = 124),
Dupuytren's contracture 14.4\% (n = 101), and adhesive capsulitis 13.8\%
(n = 97). A statistically significant relationship of the HbA1c level
with Dupuytren's contracture, carpal tunnel syndrome, and adhesive
capsulitis was detected (\emph{p} \textless{}0.05).

\textbf{Conclusions} : Patients' age, duration of diabetes, HbA1c level,
and presence of microvascular complications are associated with
musculoskeletal disorders in this population.

\textbf{Keywords:} Diabetes mellitus; Musculoskeletal Disorders; Carpal
tunnel syndrome; Dupuytren's contracture; Adhesive capsulitis

\textbf{What's already known about this topic?}

\begin{itemize}
\tightlist
\item
  Diabetes mellitus has been associated with many different
  musculoskeletal system problems.
\item
  Diabetes mellitus (DM) is a chronic and progressive metabolic disorder
  characterized by hyperglycemia due to defective insulin secretion and
  defective insulin action or both.
\item
  Diabetes causes progressive complications such as retinopathy,
  nephropathy, and neuropathy in the long term.
\item
  Musculoskeletal disorders are generally not diabetes-specific and can
  also be seen in the non-diabetic population.
\end{itemize}

\textbf{What does this article add?}

\begin{itemize}
\tightlist
\item
  Several musculoskeletal disorders have been associated with diabetes.
\item
  Musculoskeletal system disorders were detected in 322 of the 702
  individuals with diabetes evaluated in our study.
\item
  The frequency of musculoskeletal disorders increased with the presence
  of microvascular complications.
\item
  Our study also draws attention to various risk factors that are
  effective in musculoskeletal system involvement in diabetes.
\end{itemize}



\textbf{Introduction}

Diabetes mellitus (DM) is a chronic and progressive metabolic disorder
characterized by hyperglycemia due to defective insulin secretion and
defective insulin action or both.\textsuperscript{1} Diabetes causes
progressive complications such as retinopathy, nephropathy, and
neuropathy in the long term. Musculoskeletal disorders are generally not
diabetes-specific and can also be seen in the non-diabetic population.
However, its incidence has increased significantly in patients with
diabetes.\textsuperscript{2}

Musculoskeletal disorders in patients with diabetes include adhesive
capsulitis, limited joint mobility syndrome (LJMS), Dupuytren's
contracture (DC), flexor tenosynovitis (FT), carpal tunnel syndrome
(CTS), diffuse idiopathic skeletal hyperostosis (DISH), Charcot
arthropathy, diabetic muscle infarction, diabetic foot, gout and
osteoporosis. \textsuperscript{3}The pathophysiology of musculoskeletal
disorders has not been fully explained, and different mechanisms
triggered by hyperglycemia are thought to be effective. Accompanying
vasculopathy and neuropathy also cause changes in the connective
tissue.\textsuperscript{4} Although the complications in the
musculoskeletal system are prevalent, they are often overlooked.
However, the presence of these complications affects the patients'
quality of life, leading to pain and limitation of movement.

In this study, we aimed to determine the prevalence of diabetes-related
musculoskeletal disorders in our patients and the relationship of the
musculoskeletal disorders including carpal tunnel syndrome, Dupuytren's
contracture, adhesive capsulitis, flexor tenosynovitis, limited joint
mobility syndrome, Charcot arthropathy, diabetic foot\emph{,} and gout
to the patients' age, gender, type of diabetes, duration of diabetes,
HbA1c level and microvascular complications.

\textbf{Material and Methods}

In this prospective, cross-sectional study, 702 patients with diabetes
who applied to our endocrinology clinic and outpatient clinic between
March 2017 and February 2018 were consecutively included in the study,
and the musculoskeletal disorders were assessed by the same physician.
The patients with chronic arthritis due to rheumatological diseases such
as osteoarthritis and rheumatoid arthritis, and those with collagen
tissue disease, patients under 18 years of age, and those diagnosed with
gestational diabetes were not included in the study.

Informed consent was obtained from each of the participants. The study
was approved by the Ethics Committee of Celal Bayar University, Faculty
of Medicine (\#20.478.486-54). A detailed history of the patients was
taken, and a physical examination was performed. Subsequently, the
measurements of height, weight, waist circumference, and blood pressure
were made. Afterward, ophthalmic examination findings, electromyography
(EMG) results, and laboratory data were recorded from the outpatient
files.

The symptoms related to the musculoskeletal system were investigated in
these patients. The presence of LJMS was checked by the prayer sign and
tabletop sign. For the diagnosis of Dupuytren's contracture, palmar or
digital nodules were examined for findings such as pretendinous cord and
flexion contracture. In order to determine flexor tenosynovitis, the
patients were asked whether their fingers lock in flexion or extension.
Passive and active shoulder movements were evaluated. A foot examination
was performed for the presence of Hallux valgus, claw toes, pes cavus,
Charcot joint, and diabetic foot. The relationship of musculoskeletal
disorders with metabolic parameters and complications of diabetes was
also evaluated in the present study.

\textbf{Statistical Analysis}

The Statistical Packages for the Social Sciences version 15.0 (SPSS
Inc., Chicago, IL, USA) for Windows (Microsoft) was used for the data
analysis. The data obtained in the study were given as mean \selectlanguage{ngerman}± standard
deviation (SD). Sociodemographic and diagnostic variables were shown in
both numbers and percentages. The Student t-test was used for comparing
two independent groups with normal distribution, One-way ANOVA (Analysis
of Variance) for comparing more than two independent groups, and the
Mann Whitney U test was used to compare two independent groups for
variables without normal distribution. The relationship between
categorical variables was tested by chi-square analysis. A\emph{p}
-value of less than 0.05 was accepted as statistically significant.

\textbf{Results}

The average age of the 702 diabetic patients evaluated in our study was
55.9 ± 13.2 years. Out of all patients, 55.1\% (n = 387) were female and
44.9\% (n = 315) were male, and 8.1\% (n = 57) were diagnosed with type
1 diabetes and 91.9\% (n = 645) with type 2 diabetes. The demographic
and diabetes-related data of the patients are shown in \textbf{Table 1}
.

Musculoskeletal system problems were present in 45.9\% (n = 322) of the
patients included in the study. While 22.4\% (n = 157) of the patients
had a single finding, 23.5\% (n = 155) had two and more findings
together. The frequency of musculoskeletal system disorders were as
follow: Carpal tunnel syndrome in 17.7\% (n = 124), Dupuytren's
contracture in 14.4\% (n = 101), limited joint mobility syndrome in
10.2\% (n = 72), adhesive capsulitis in 13.8\% (n = 97), flexor
tenosynovitis in 2.8\% (n = 20), diabetic foot in 6\% (n = 39) and
Charcot arthropathy in 1.7\% (n = 12). The most common musculoskeletal
disorder was carpal tunnel syndrome, and bilateral involvement of the
disease was observed in 46.7\% (n = 58) of patients. Dupuytren's
contracture was found to be more common in patients with type 2 diabetes
compared to patients with type 1 diabetes (15\% and 1.8\%,
respectively), and this result was statistically significant (p =
0.015). The relationship of musculoskeletal disorders with the type of
diabetes is shown in \textbf{Table 2} .

The relationship of the musculoskeletal disorders with age and the
duration of diabetes was evaluated. There was a statistically
significant relationship between Dupuytren's contracture
(\emph{p}\textless{} 0.001), LJMS (\emph{p} \textless{}0.001) and
diabetic foot (\emph{p} = 0.021) and the mean patient age. The duration
of diabetes was associated with Dupuytren's contracture, adhesive
capsulitis, carpal tunnel syndrome, flexor tenosynovitis, and limited
joint mobility syndrome (p \textless{}0.005).

In our study, the relationship between HbA1c level and musculoskeletal
disorders was demonstrated. HbA1c levels were higher in patients with
musculoskeletal disorders, and there was a statistically significant
difference in Dupuytren's contracture (\emph{p} \textless{}0.001),
adhesive capsulitis (\emph{p} = 0.048), and carpal tunnel syndrome
(\emph{p} = 0.045). The relationship between musculoskeletal disorders
and HbA1c is shown in \textbf{Figure 1} .

The proteinuria level was also higher in patients with musculoskeletal
manifestations. However, a statistically significant relationship with
proteinuria was found only between flexor tenosynovitis and diabetic
foot (p \textless{}0.05). An association between microvascular
complications and musculoskeletal disorders was also found. A
significant relationship between Dupuytren's contracture and diabetic
foot with all of the microvascular complications was detected. A
relationship between adhesive capsulitis and retinopathy was also found
to be significant. Likewise, there was a substantial relationship of
LJMS and flexor tenosynovitis with nephropathy. The relationship of
musculoskeletal system disorders with microvascular complications, age,
duration of diabetes, HbA1c, and proteinuria are shown in \textbf{Table
3.}

\textbf{Discussion}

Several musculoskeletal disorders have been associated with diabetes.
The prevalence of musculoskeletal disorders in patients with diabetes
has increased compared to the healthy population.\textsuperscript{2,5-7}
Musculoskeletal system disorders were detected in 322 (45.9\%) of the
702 diabetic patients evaluated in our study. The frequency of
musculoskeletal system disorders ranged from 36\% to 75\% in other
researches.\textsuperscript{2,8-10} The variability may be caused by the
inclusion of different patient populations in those studies in terms of
the distribution of diabetes duration and types.

Carpal tunnel syndrome (CTS) is a trap neuropathy that develops as a
result of compression of the median nerve under the transverse carpal
ligament at the wrist. Nerve compression can also stem from the
thickening and abnormal growth of the connective tissue. In studies
conducted in the literature, the frequency of carpal tunnel syndrome was
found to vary between 5.3\% and 41.7\%.\textsuperscript{2,7,9,11,12} In
a study of 432 patients with diabetes by Kiani et
al.\textsuperscript{12}, the prevalence of CTS was found to be 8\%, and
it was shown that there was a significant relationship between female
gender and duration of diabetes. In the study of Khader et
al.\textsuperscript{9} , it was emphasized that obesity is related to
CTS. In our research, the most common musculoskeletal finding was carpal
tunnel syndrome (17.7\%), and there was a statistically significant
correlation between HbA1c level and carpal tunnel syndrome (\emph{p} =
0.045). In some studies, the relationship between CTS and microvascular
complications has been investigated, and an association has been shown
between CTS and retinopathy. \textsuperscript{9,13} In our study, there
was no difference in the frequency of CTS with the presence of
retinopathy and nephropathy, while it was observed that it was
significantly more common in those with neuropathy \textbf{(Table 3).}

Dupuytren's contracture is a fibroproliferative disease of palmar and
digital fascia, characterized by abnormal scar tissue formation in the
palmar region of the hand. Its frequency was reported to be between 13\%
and 39\% in patients with diabetes. \textsuperscript{5,14} In our study,
the frequency of Dupuytren's contracture was found to be 14.4\%.
Rajendran et al. \textsuperscript{7} reported a higher Dupuytren's
contracture prevalence (42\%) in their study composed of 206 patients
with type 2 diabetes. Similar to our results, the frequency of
Dupuytren's contracture was found to be 13\% in a study by Ramchurm et
al.\textsuperscript{2} In the study of Pandey et
al.\textsuperscript{13}, Dupuytren's contracture was found to be 19\%,
and the relationship with the HbA1c level was shown in
patients\textbf{.} In our study, Dupuytren's contracture was found to be
associated with the HbA1c level, as shown in \textbf{Table 3.} In
studies conducted, Dupuytren's contracture was found to be related to
the presence of neuropathy and retinopathy, which are microvascular
complications.\textsuperscript{9,13} In our study, Dupuytren's
contracture was found to be significantly associated with all
microvascular complications.

Adhesive capsulitis is characterized by painful, gradual loss of active
and passive shoulder motion resulting from fibrosis and contracture of
the joint capsule. The prevalence of adhesive capsulitis differs in the
research depending on the criteria used for diagnosis and the population
investigated. This difference is thought to occur due to the fact that
calcific tendinitis of the shoulder is not included in some studies
since imaging technologies are not used. In a meta-analysis evaluating
18 studies by Zreik et al. \textsuperscript{15}, the prevalence of
adhesive capsulitis in diabetes was found to be five times higher than
in the normal population. Its frequency varied between 19\% and 29\% in
patients with diabetes. \textsuperscript{14,16} The frequency of
adhesive capsulitis was found to be 13.8\% in our study, and its
prevalence was similar to the studies in the literature. Ardic et
al.\textsuperscript{6} found the frequency of adhesive capsulitis as
12.8\% in their research. In another study, the frequency of adhesive
capsulitis was found to be 29\%, and the relationship with age and
duration of diabetes was shown. At the same time, adhesive capsulitis
was compared with other complications of diabetes and was associated
with the presence of retinopathy. \textsuperscript{16,17} In our study,
a significant relationship was found between adhesive capsulitis and
neuropathy, and retinopathy \textbf{(Table 3).}

The limited joint mobility syndrome is characterized by flexion
contractures, especially in small joints, and thickening and hardening
of the skin on the back of the hand and fingers. Its prevalence varies
between 8\% and 60\% in patients with
diabetes.\textsuperscript{2,7-9,11,13} Mathew et al.
\textsuperscript{10} found the frequency of LJMS as 8.06\% in their
study. Similarly, LJMS prevalence was found to be 10.2\% in our study.
In a study in which Frost et al. \textsuperscript{18} evaluated 335
patients with type 1 diabetes, the relationship between the presence of
LJMS and nephropathy and retinopathy, especially in men, was
demonstrated. When we evaluated our study in terms of microvascular
complications, there was a significant relationship between LJMS and the
presence of nephropathy

\textbf{(Table 3).}

Flexor tenosynovitis (Trigger Finger) is characterized by localized
thickening, palpable nodule formation, and triggering during finger
movements in the flexor tendon sheath.\textsuperscript{19} Yosipovitch
et al. \textsuperscript{19} found flexor tenosynovitis to be 5\%. In our
study, the frequency of flexor tenosynovitis was found to be 2.8\%. In
the literature, there are studies reporting a higher rate of flexor
tenosynovitis. \textsuperscript{2,6,11,19} Pandey et al. did not show a
relationship between microvascular complications and flexor
tenosynovitis, and Khader et al. associated
retinopathy.\textsuperscript{9,13} In our study, there was no
relationship between flexor tenosynovitis, neuropathy, and retinopathy,
but a significant association was found with the presence of nephropathy
\textbf{(Table 3).}

In patients with diabetes, Charcot arthropathy is a reduction in the
normal afferent protective neural impulses, and therefore loss of
protection from trauma to the joint leads to progressive, painless joint
destruction.\textsuperscript{20} Charcot arthropathy is found to be in
0.1-5\% of patients with diabetes. It is more common in type 2 diabetes
and is equally common in men and women. The incidence increases with the
duration of diabetes.\textsuperscript{21} In our study, Charcot
arthropathy was found to be 1.7\%. In a study published by Agrawal et
al.\textsuperscript{8}, the frequency of Charcot arthropathy was found
to be 2.9\%. In the study conducted by Stuck et al.\textsuperscript{22},
the data of 652 patients with diabetes diagnosed with Charcot
arthropathy were evaluated, and it was emphasized that the duration of
diabetes was associated with Charcot arthropathy. In the same study, the
incidence of Charcot arthropathy increased in patients with neuropathy
and those with HbA1c levels above 7\%. In our study, no relationship was
found between metabolic parameters and microvascular complications in
patients diagnosed with Charcot arthropathy.

The frequency of diabetic foot was found to be 6\% in our study. In the
study conducted by Ardic et al. \textsuperscript{6}, the frequency of
diabetes foot was reported to be 6.4\% and was associated with
retinopathy. In a study evaluating 811 patients with type 2 diabetes by
Kumar et al.,\textsuperscript{23} the prevalence of diabetic foot was
found to be 5.3\%. In our study, the diabetic foot was associated with
age and duration of diabetes. A significant correlation was shown
between the mean fasting blood glucose and proteinuria levels of the
metabolic parameters and the diabetic foot. The relationship between all
microvascular complications and diabetic foot was observed

\textbf{(Table 3).}

Our study has some limitations. Firstly, we did not have a control
group. Secondly, a relatively small number of patients with type 1
diabetes were included in our study. However, musculoskeletal disorders
have been shown to occur more frequently in people with type 1 diabetes
when compared with the non-diabetic subject.\textsuperscript{24} Next,
we could not evaluate osteoarthritis and rheumatoid arthritis in this
study.

On the other hand, the prospective nature of the study, evaluation of
the patients by the same physician, and a relatively large number of the
study population could be designated as the strengths of the current
paper. Furthermore, our results have shed light on the pathogenesis of
musculoskeletal disorders by means of assessing the relationship between
metabolic parameters and microvascular complications.

Therefore, we suggest that further larger prospective studies with
control groups are required to understand the mechanisms and prevention
of these frequent but under-studied complications of type 1 and type 2
diabetes.

As a result of our study, 45.9\% (n = 322) of the 702 diabetic patients
showed signs of musculoskeletal system disorders. The most common
disorders were carpal tunnel syndrome, Dupuytren's contracture, and
adhesive capsulitis. Our study also draws attention to various risk
factors that are effective in musculoskeletal system involvement in
diabetes. These risk factors are age, duration of diabetes, HbA1c level
as a marker of glycemic control, and presence of microvascular
complications. A statistically significant relation was found between
the duration of diabetes and all musculoskeletal disorders except
Charcot arthropathy and between HbA1c level and Dupuytren's contracture,
carpal tunnel syndrome, and adhesive capsulitis. In addition, the
frequency of musculoskeletal disorders increased with the presence of
microvascular complications.

\textbf{Acknowledgments}

\textbf{Funding} : This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-profit sectors.

\textbf{Conflicts of Interest/Competing Interests} : The authors declare
they have no conflict of interest

\textbf{Availability of data and material} : The authors confirm that
the data supporting the findings of this study are available within the
article and/or its supplementary materials.

\textbf{Code availability} : Not Applicable

\textbf{Ethics approval:} The study was approved by the Ethics Committee
of Celal Bayar University, Faculty of Medicine.

\textbf{Consent to participate:} Informed consent was obtained from each
of the participants



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\textbf{Table 1. Demographic and diabetes-related data of the patients}\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
& & Total (n=702) & & & & &\tabularnewline
\midrule
\endhead
& & N & \% & & & &\tabularnewline
Gender & Female & 387 & 55.1 & & & &\tabularnewline
& Male & 315 & 44.9 & & & &\tabularnewline
Age & [?] 50 & 196 & 27.9 & & & &\tabularnewline
& \textgreater{} 50 & 506 & 72.1 & & & &\tabularnewline
Duration of Diabetes (years) & [?] 5 & 284 & 40.5 & & & &\tabularnewline
& 5-10 & 183 & 26.1 & & & &\tabularnewline
& \textgreater{}10 & 235 & 33.5 & & & &\tabularnewline
Body Mass Index (kg/m\textsuperscript{2}) & [?]25 & 152 & 21.7 & & &
&\tabularnewline
& \textgreater{}25 & 550 & 78.3 & & & &\tabularnewline
Type of Diabetes & Type 1 & 57 & 8.1 & & & &\tabularnewline
& Type 2 & 645 & 91.8 & & & &\tabularnewline
Concomitant disease & Hypertension & 349 & 49.5 & & & &\tabularnewline
& No hypertension & 353 & 50.5 & & & &\tabularnewline
HbA1c (\%) & [?] 7 & 268 & 38.8 & & & &\tabularnewline
& \textgreater{} 7 & 424 & 60.4 & & & &\tabularnewline
& Missing & 10 & 1.4 & & & &\tabularnewline
Macrovascular Complications (MC) & CAD & 101 & 14.4 & & &
&\tabularnewline
& PAD & 1 & 0,1 & & & &\tabularnewline
& CVD & 11 & 1.6 & & & &\tabularnewline
& CAD + CVD & 3 & 0.4 & & & &\tabularnewline
& CAD +PAD & 6 & 0.9 & & & &\tabularnewline
& No MC & 580 & 82.6 & & & &\tabularnewline
Microvascular Complications & Retinopathy & 188 & 26.8 & & &
&\tabularnewline
& No Retinopathy & 514 & 73.2 & & & &\tabularnewline
& Neuropathy & 339 & 48.3 & & & &\tabularnewline
& No Neuropathy & 363 & 51.7 & & & &\tabularnewline
& Nephropathy & 191 & 27.2 & & & &\tabularnewline
& No Nephropathy & 511 & 72.8 & & & &\tabularnewline
\emph{CAD} Coronary artery disease, \emph{PAD} Peripheral artery
disease, \emph{CVD} Cerebrovascular disease & \emph{CAD} Coronary artery
disease, \emph{PAD} Peripheral artery disease, \emph{CVD}
Cerebrovascular disease & \emph{CAD} Coronary artery disease, \emph{PAD}
Peripheral artery disease, \emph{CVD} Cerebrovascular disease &
\emph{CAD} Coronary artery disease, \emph{PAD} Peripheral artery
disease, \emph{CVD} Cerebrovascular disease & \emph{CAD} Coronary artery
disease, \emph{PAD} Peripheral artery disease, \emph{CVD}
Cerebrovascular disease & \emph{CAD} Coronary artery disease, \emph{PAD}
Peripheral artery disease, \emph{CVD} Cerebrovascular disease &
\emph{CAD} Coronary artery disease, \emph{PAD} Peripheral artery
disease, \emph{CVD} Cerebrovascular disease & \emph{CAD} Coronary artery
disease, \emph{PAD} Peripheral artery disease, \emph{CVD}
Cerebrovascular disease\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2. The relationship of musculoskeletal disorders with the
type of diabetes}\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
Musculoskeletal disorders & Type of Diabetes & Type of Diabetes & Type
of Diabetes & Type of Diabetes & Total (n=702) & Total (n=702) &
\emph{P*}\tabularnewline
\midrule
\endhead
& \textbf{Type 1 (n=57)} & \textbf{Type 1 (n=57)} & \textbf{Type
2(n=645)} & \textbf{Type 2(n=645)} & & &\tabularnewline
& \textbf{n} & \textbf{\%} & \textbf{n} & \textbf{\%} & \textbf{n} &
\textbf{\%} &\tabularnewline
Dupuytren's contracture & 1 & 1,8 & 100 & 15 & 101 & 14.4 &
\textbf{0,015}\tabularnewline
Adhesive capsulitis & 2 & 3 & 95 & 14 & 97 & 13.8 & 0,059\tabularnewline
Carpal tunnel syndrome & 4 & 7,1 & 120 & 18,6 & 124 & 17.7 &
0,076\tabularnewline
Flexor tenosynovitis & 1 & 1,8 & 19 & 2,9 & 20 & 2.8 &
0,679\tabularnewline
LJMS & 3 & 5 & 71 & 11 & 74 & 10.2 & 0,396\tabularnewline
Charcot arthropathy & 1 & 1,8 & 11 & 1,7 & 12 & 1.7 &
0,641\tabularnewline
Diabetic foot & 3 & 5 & 39 & 6 & 42 & 6.0 & 0,550\tabularnewline
Gout & 2 & 3.5 & 9 & 1.3 & 11 & 1.6 & 0.400\tabularnewline
\bottomrule
\end{longtable}

\emph{*Pearson chi-square}

\textbf{Table 3.} The relationship of musculoskeletal system disorders
with microvascular complications, age, duration of diabetes, HbA1c, and
proteinuria\selectlanguage{english}
\begin{longtable}[]{@{}llllllllllll@{}}
\toprule
\begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Musculoskeletal Disorders\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Musculoskeletal Disorders\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Age (years)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Duration of Diabetes (years)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Duration of Diabetes (years)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
HbA1c (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
HbA1c (\%)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Proteinuria (mg/day)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Retino pathy (n)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Neuro pathy (n)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Neuro pathy (n)\strut
\end{minipage} & \begin{minipage}[b]{0.08\columnwidth}\raggedright\strut
Nephropathy (n)\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Dupuytren's contracture*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
92,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
92,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
143\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
272\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
152\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
152\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Unilateral\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
61,5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
61,5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
11,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
114,7\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
114,7\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
24\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
34\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
16\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
16\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Bilateral\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
65,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
65,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
13,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
9,1\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
136\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
136\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
13\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
20\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
13\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
13\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\emph{P}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,829\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,829\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,040}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,040}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Carpal tunnel syndrome*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,0\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
98,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
98,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
148\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
256\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
156\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
156\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Unilateral\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
11,2\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
30,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
30,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
20\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
45\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
17\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
17\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Bilateral\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
59,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
59,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
11,5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
130,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
130,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
20\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
38\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
18\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
18\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\emph{P}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,112\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,112\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,045}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,378\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,378\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,275\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,776\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,776\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Adhesive capsulitis*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
97\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
97\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
152\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
277\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
161\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
161\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Unilateral\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
56,7\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
56,7\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
10,1\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
83,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
83,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
28\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
49\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
25\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
25\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Bilateral\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
60,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
60,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
13,5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
9,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
98,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
98,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
13\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
5\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\emph{P}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,232\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,232\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,048}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,961\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,961\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,028}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,002}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,673\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,673\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Limited joint mobility syndrome**\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,2\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,2\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,1\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
91,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
91,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
163\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
300\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
162\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
162\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
61,7\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
61,7\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
11\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
7,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
126,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
126,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
25\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
39\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
29\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
29\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\emph{P}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,025}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,432\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,504\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,504\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,201\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,316\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,021}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,021}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Flexor tenosynovitis*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,1\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
90,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
90,3\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
179\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
324\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
180\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
180\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
59,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
59,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
15,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,7\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
259,5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
259,5\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
15\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
11\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
11\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\emph{P}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,422\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,422\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,002}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,417\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,021}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,021}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,057\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,081\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,014}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,014}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Charcot arthropathy***\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,1\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
92,2\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
92,2\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
182\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
331\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
185\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
185\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
54,1\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
54,1\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
9,2\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,7\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
284,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
284,9\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\emph{P}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,509\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,509\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,761\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,800\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,207\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,207\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,072\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,160\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,077\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,077\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Diabetic foot**\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
55,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8,8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
88,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
88,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
161\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
302\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
172\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
172\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
56,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
56,6\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
11\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
9,2\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
205,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
205,4\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
27\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
37\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
19\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
19\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\emph{P}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,021}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,021}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,015}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
0,124\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,023}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{0,023}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{\textless{}0.001}\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

* Oneway ANOVA

** Student's t-test

***Mann-Whitney U Test

(\emph{P} -value of less than 0.05 was accepted as statistically
significant)

\textbf{Figure Legend}

\textbf{Fig. 1.} The relationship between musculoskeletal disorders and
HbA1c

\textbf{Hosted file}

\verb`Figure 1.docx`  available at \url{https://authorea.com/users/431050/articles/534579-the-musculoskeletal-disorders-in-diabetic-patients-and-the-evaluation-of-their-relationship-with-metabolic-parameters-and-microvascular-complications}

\textbf{Hosted file}

\verb`Table 1.docx`  available at \url{https://authorea.com/users/431050/articles/534579-the-musculoskeletal-disorders-in-diabetic-patients-and-the-evaluation-of-their-relationship-with-metabolic-parameters-and-microvascular-complications}

\textbf{Hosted file}

\verb`Table 2.docx`  available at \url{https://authorea.com/users/431050/articles/534579-the-musculoskeletal-disorders-in-diabetic-patients-and-the-evaluation-of-their-relationship-with-metabolic-parameters-and-microvascular-complications}

\textbf{Hosted file}

\verb`Table 3.docx`  available at \url{https://authorea.com/users/431050/articles/534579-the-musculoskeletal-disorders-in-diabetic-patients-and-the-evaluation-of-their-relationship-with-metabolic-parameters-and-microvascular-complications}

\selectlanguage{english}
\FloatBarrier
\end{document}

